First page of the downloadable care feedback and complaints template

Actual document preview · DOCX · 2pages

care feedback and complaints template

Preview the first page before downloading. Open the image to read it at full size.

Download free DOCXEnlarge preview (opens a new tab)

No email or account needed to download.

Download the care feedback and complaints template (Word DOCX). No email or account is needed.

Write feedback or explain a complaint in your own words. You can ask someone to help. You do not have to use this form to raise a concern.

What is in the download

My feedback or complaint

How I want to be contacted. Service involved. What happened. Impact on me. What I want to happen. Help and communication. Sharing preferences. Date and next step.

Provider response and action record

Received and acknowledged. Immediate safety action. Person preferences. Review. Response. Actions. External options. Follow-up.

How to use it

  1. Save a working copy and replace the bracketed prompts. Remove sections that do not apply.
  2. Involve the person in the discussion and use their preferred communication format.
  3. Verify dates, contacts and source records. Clearly attribute information supplied by someone else.
  4. Record who completed the document and when. Make later corrections traceable.
  5. Share only necessary information with the appropriate recipient and retain the record securely.

Before you rely on it

For an immediate emergency call 000. An internal complaint does not replace required incident notification. People may contact the relevant regulator directly. NDIS provider complaints and complaints about an NDIA decision use different processes. For aged care, use the Aged Care Quality and Safety Commission complaints pathway.

Find more free care templates. These documents support the work of providers, coordinators and participants; Carevo is a connection platform.